Katharine Hall was awarded first prize for the best paper presentation (South African) (clinical) at the recent 4th South African AIDS Conference in Durban. The paper was authored by the CI’s Helen Meintjes, Katharine Hall and Double-Hugh Marera, and Andrew Boulle from the School of Public Health and Family Medicine, UCT.

The paper is titled: Orphans of the AIDS Epidemic? The extent, nature and circumstances of child-headed households in South Africa. It addresses widespread concern that the numbers of children in ‘child-headed households’ are rapidly increasing due to AIDS-related adult mortality. Based on an analysis of national household survey data over a seven-year period, the paper explores trends in the numbers of children living in child-only households, and characterises these children relative to children in households with adults (mixed-generation households).

The findings show that, contrary to popular perception, the proportion of child-only households is relatively small and does not appear to be increasing despite substantial increases in HIV prevalence and orphaning over the same period. Importantly, the vast majority of children in child-only households have a living parent. The findings raise critical questions about the circumstances leading to the formation of child-only households, and highlight that they cannot for the main part be ascribed to HIV orphaning. However, the numbers of children living in this household form are not insignificant, and their circumstances, when compared with children in mixed-generation households, indicate a range of challenges, including greater economic vulnerability and inadequate service access.

The authors argue that a solitary focus on the HIV pandemic and related orphaning as the cause of child-only households masks other important issues for consideration when addressing their needs, and risks the development of inappropriate policies.